The essential
features of substance-induced anxiety disorder are prominent and persistent
feelings of anxiety that are judged to be due to the direct physiological
effects of intoxication or withdrawal from a substance. Prominent
anxiety, Panic Attacks, or obsessions or compulsions predominate in
the clinical picture.
There is evidence
from the history, physical examination, or laboratory findings of
either:
The symptoms developed during, or within 1 month of, Substance Intoxication
or Withdrawal.
The symptoms persist for a substantial period of time (e.g., about
a month) after the cessation of acute withdrawal or severe intoxication
or are substantially in excess of what would be expected given the
type or amount of the substance used or the duration of use.
Medication use is etiologically related to the disturbance.
There is other evidence suggesting the existence of an independent
non-substance-induced Anxiety Disorder (e.g., a history of recurrent
non-substance-related episodes).
The disturbance does not occur exclusively during the course of a
Delirium.
The disturbance causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
The disturbance is not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication) or a general medical
condition.
With Generalized
Anxiety: if excessive anxiety or worry about a number of events or
activities predominates in the clinical presentation.
With Panic Attacks: if Panic Attacks predominate in the clinical presentation.
With Obsessive-Compulsive Symptoms: if obsessions or compulsions predominate
in the clinical presentation.
With Phobic Symptoms: if phobic symptoms predominate in the clinical
presentation.
Specify if:
With Onset During Intoxication: if the criteria are met for Intoxication
with the substance and the symptoms develop during the intoxication
syndrome.
With Onset During Withdrawal: if criteria are met for Withdrawal from
the substance and the symptoms develop during, or shortly after, a
withdrawal syndrome.
Alcohol
Because alcohol has depressive properties, acute intoxication rarely
involves acute anxiety or panic. However, acute alcohol withdrawal,
may induce an anxiety disorder. Various degrees of subclinical anxiety
ranging from panic to generalized anxiety can last for 3-12 months
after cessation of drinking.
Cocaine
& Psychostimulants
Cocaine & other psychostimulants may produce manifestations of
anxiety, most commonly during the intoxication state.
Opiates
Opiate withdrawal actually may share neurochemical characteristics
with panic disorder. also protracted anxiety during methadone withdrawal
may last several weeks or months.
Cannabis
Marijuana-induced anxiety usually occurs at high doses.
Phencyclidine
& Other Hallucinogens
PCP & hallucinogens may acutely produce anxiety & panic, depending
on the individual, dose & setting.
Miscellaneous
More commonly used drugs such as caffeine & nicotine withdrawal,
may also produce anxiety symptoms.
Associated
Features:
Substance-induced
anxiety disorder may be experienced by individuals with no preexisting
psychopathology as well as those who have a history of erratic or
maladaptive behavior. On the other hand, these episodes usually occur
in individuals with preexisting anxiety about drug use, especially
novice users or in experienced users who have taken more than their
usual dose.
Differential
Diagnosis
Some disorders
have similar symptoms. The clinician, therefore, in his diagnostic
attempt has to differentiate against the following disorders which
need to be ruled out to establish a precise diagnosis.
None Identified.
Cause:
Due to the direct
physiological effects of intoxication or withdrawal from a substance.
Treatment:
Cessation
of the particular substance.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Drug counselling
may also form part of the treatment regime.
